“Antimicrobial Therapy” … Case Conclusion has been posted January 9, 2012
Posted by ebmedicine in Drugs & Emergency Procedures, Infectious Disease.add a comment
The latest What’s Your Diagnosis challenge conclusion, titled “Antimicrobial Therapy … Case Conclusion,” has been posted on our new location; check it out here.
Antimicrobial Therapy… January 1, 2012
Posted by ebmedicine in Drugs & Emergency Procedures, Infectious Disease.add a comment
The latest What’s Your Diagnosis challenge, titled “Antimicrobial Therapy,” has been posted on our new location; check it out here.
“Gunshot Wound” … Case Conclusion December 6, 2011
Posted by ebmedicine in Traumatic Emergencies.add a comment
The Conclusion Is…
The patient was taken to the operating room immediately. On visual inspection during thoracotomy, he was found to have a diaphragmatic injury. He required a left-lower-lobe resection but did not have any other intra-abdominal injuries, and he recovered slowly over several weeks.
Congratulations to Dr. Arellano, Dr. Arosemena, Dr. Saltzberg, Dr. Soliman, and Dr. Tsukerman — this week’s winners of Emergency Medicine Practice’s “Ballistic Injuries In The Emergency Department!” For a discussion of the emergency department (ED) management of gunshot wounds to the head, neck, thorax, abdomen, and extremities, read this issue.
Gunshot Wound… November 21, 2011
Posted by ebmedicine in Traumatic Emergencies.14 comments
A 25-year-old man presents to the ED via ambulance after sustaining a single gunshot wound to the upper abdomen. There is no apparent exit wound. He is awake, in obvious pain and distress, with labored spontaneous breathing. He was reportedly shot with a handgun at close range, and there was significant blood loss at the scene. He has decreased breath sounds on the left side and a mildly tender abdomen with a small wound over the left anterior lower chest. A FAST examination shows no free fluid in the abdomen and no pericardial effusion. A left-sided chest tube is placed, with 200 mL of blood out immediately, and subsequent chest x-ray shows a right hemothorax with a bullet lodged in the left lower lobe.
Are additional tests needed before this patient arrives for surgery? What is this patient’s likely outcome?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your answers to the questions above. To do so, simply enter your response in the comments box. The deadline to enter is December 6th.)
“Trauma Patient” … Case Conclusion November 7, 2011
Posted by ebmedicine in Cardiovascular Emergencies, Hematologic/Allergic/Endocrine Emergencies, Traumatic Emergencies.add a comment
The Conclusion Is…
This patient was in hemorrhagic shock with hemoperitoneum. The MTP was activated, and the patient was given a dose of TXA. Surgical consultation was delayed by a prior patient. Blood products were brought to the bedside, and crystalloid administration was strictly limited. The patient’s blood pressure remained steady around 80/50 mm Hg, and he continued to be alert, with good peripheral pulses. Initial labs came back and showed a normal hemoglobin, but elevated PT. Two units of PRBCs and 2 units of FFP were transfused through a fluid warmer. These brought the patient’s blood pressure up to 100/60 mm Hg and heart rate down to 100 beats per minute. The patient remained stable until surgical consultation arrived. Because of his demonstrated stability, he underwent a CT scan, which showed a grade 3 liver injury with a blush. He was taken to the angiography suite and his liver injury was embolized. The patient was monitored in the ICU and did well, never requiring an operation. He was discharged home after 1 week in the hospital.
Congratulations to Dr. Anthony, Dr. Ebeid, Dr. Mbinga, Dr. Park, and Dr. Salah — this week’s winners of Emergency Medicine Practice’s “Traumatic Hemorrhagic Shock: Advances In Fluid Management!” For an evidence-based review of the treatment of critically injured patients in hemorrhagic shock, read this issue.
Trauma Patient… October 19, 2011
Posted by ebmedicine in Cardiovascular Emergencies, Hematologic/Allergic/Endocrine Emergencies, Traumatic Emergencies.18 comments
EMS arrives with a 24-year-old male who was the victim of a hit-and-run accident in which the driver apparently backed over him after first clipping him with the car and knocking him to the ground. When you walk into the patient’s room, you find him awake and angry, complaining of pain in his right upper quadrant. He is on a backboard, wearing a cervical collar, and has obvious bruising to the right chest and abdomen. His airway is patent and his breath sounds are equal bilaterally. The patient’s initial vital signs are: heart rate of 125 beats per minute, blood pressure of 120/80 mm Hg, respiratory rate of 20 breaths per minute, temperature of 98°F (36.6°C), and SpO2 of 94% on room air. Per EMS, the patient was hypotensive on their arrival, with initial blood pressure of 80/40 mm Hg, but it rapidly improved with 2 L of crystalloid given in the field. A second large-bore IV is placed and labs are drawn. The FAST examination reveals significant hemoperitoneum. He then becomes diaphoretic, and repeat blood pressure is now 75/40 mm Hg. The nurse asks if you want 2 more liters of crystalloid.
What is your next step?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your answers to the questions above. To do so, simply enter your response in the comments box. The deadline to enter is November 6th.)
“Upset stomach” … Case Conclusion October 7, 2011
Posted by ebmedicine in Abdominal Emergencies.add a comment
The patient in the second case presented very atypically. The emergency clinician was going to send her home with a UTI, but luckily she started vomiting while in the ED and then spiked a fever. A CT with rectal contrast demonstrated an enlarged, necrotic appendix, and the patient underwent laparoscopic appendectomy without complication. This patient was a reminder that elderly patients with appendicitis often present atypically and that a high clinical suspicion and a low threshold to order imaging in this patient population is warranted. Furthermore, urinalysis may demonstrate nonspecific inflammatory signs in an appendicitis patient of any age.
Congratulations to Dr. Dube, Imad, Dr. Orecchioni, Dr. Shafey Dr. Zubair — this week’s winners of Emergency Medicine Practice’s “Evidence-Based Management Of Suspected Appendicitis In The Emergency Department!” For an evidence-based discussion of the most current findings in regard to the diagnosis of appendicitis in the emergency department (ED) (with particular attention towards elucidating the elements of history, physical examination, and laboratory testing that will most benefit the emergency clinician faced with the dilemma of diagnosing possible appendicitis), read this issue.
“Upset stomach…” September 20, 2011
Posted by ebmedicine in Abdominal Emergencies.22 comments
A 62-year-old female presents with an “upset stomach,” suprapubic discomfort, and dysuria over the last 12 hours. She said this feels similar to UTIs that she’s had in the past, so she took a ciprofloxacin this morning with no relief. She is afebrile with stable vital signs and a soft abdomen with mild suprapubic tenderness with trace rebound, no guarding. Labs returned with WBCs of 10 and RBC of 5, with negative nitrates, bacteria, and squamous cells. She states that she still feels “uncomfortable in her stomach” but otherwise is without complaints.
What is your next step?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your answers to the questions above. To do so, simply enter your response in the comments box. The deadline to enter is October 6th.)
